免输尿管鞘输尿管软镜联合钬激光治疗上尿路结石53例

目的：探讨输尿管软镜免输尿管鞘直接进入输尿管上段及肾盂肾盏内行钬激光碎石的适应证及安全性。方法回顾分析我科室2011年11月至2013年12月行免输尿管鞘输尿管软镜联合钬激光治疗的53例上尿路结石患者的临床资料。结果53例均1次进镜成功，均成功找到结石，手术时间15～40 min，平均27 min。2例术后出现高热症状，6例术后肾周有少量积液。无其他严重并发症。术后1个月复查，3例残留结石约0.5 cm，行体外震波碎石，16例肾下盏残留数量不等的0.3 cm大小残石，建议体位排石后2周后复查均消失。结论不大于2 cm结石可免输尿管鞘行输尿管软镜下激光碎石，安全可行，节约成本。

Flexible ureteroscopy without ureteral access sheath combined with holmium laser lithotripsy for 53 cases of upper urinary tract calculi

Objective To evaluate the indication and safety of the flexible ureteroscopy without ureteral ac-cess sheath combined with Holmium laser lithotripsy for upper urinary tract calculi. Methods From Nov. 2011 to Dec. 2013, 53 cases with upper urinary tract calculi were treated by flexible ureteroscopy without ureteral access sheath combined with Holmium laser lithotripsy in our hospital. Results The insertion of flexible ureteroscopy was successful in all cases in the first time, and the calculi were all detected, and the average operation time was 27minutes （15~40 mins）. Two patients had hyperpyrexia and 6 cases had perinephric effusion after operation, and no other serious complication occurred. About 0.5 cm stone residual was found in 3 cases, then disappeared after ESWL, and 0.3 cm stones were found in 16 patients 1 month after operation, which were advised posture calculus discharging, and stones disappeared after 2 weeks. Conclusion Flexible ureteroscopy without ureteral access sheath combined holmium la-ser lithotripsy is a safe and economic procedure for upper tract calculi with the diameter not more than 2 cm.